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2.
Ann Surg ; 263(4): 745-50, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25790120

RESUMO

UNLABELLED: This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio=1.54; 95% CI: 1.12-2.11). OBJECTIVE: To evaluate the association between hospital volume and CRM (circumferential resection margin) involvement in rectal cancer surgery. BACKGROUND: To guarantee the quality of surgical treatment of rectal cancer, the Association of Surgeons of the Netherlands has stated a minimal annual volume standard of 20 procedures per hospital. The influence of hospital volume has been examined for different outcome variables in rectal cancer surgery. Its influence on the pathological outcome (CRM) however remains unclear. As long-term outcomes are best predicted by the CRM status, this parameter is of essential importance in the debate on the justification of minimal volume standards in rectal cancer surgery. METHODS: Data from the Dutch Surgical Colorectal Audit (2011-2012) were used. Hospital volume was divided into 3 groups, and baseline characteristics were described. The influence of hospital volume on CRM involvement was analyzed, in a multivariate model, between low- and high-volume hospitals, according to the minimal volume standards. RESULTS: This study included 5161 patients. CRM was recorded in 86% of patients. CRM involvement was 11% in low-volume group versus 7.7% and 7.9% in the medium- and high-volume group (P≤0.001). After adjustment for relevant confounders, the influence of hospital volume on CRM involvement was still significant odds ratio (OR) = 1.54; 95% CI: 1.12-2.11). CONCLUSIONS: The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/normas , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Indicadores de Qualidade em Assistência à Saúde , Neoplasias Retais/cirurgia , Reto/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Neoplasias Retais/patologia , Reto/cirurgia
3.
Ann Surg Oncol ; 22(11): 3582-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25691277

RESUMO

BACKGROUND AND PURPOSE: Surgeons and hospitals are increasingly accountable for their postoperative complication rates, which may lead to risk adverse treatment strategies in rectal cancer surgery. It is not known whether a risk adverse strategy leads to providing better care. In this study, the association between the strategy of hospitals regarding defunctioning stoma construction and postoperative outcomes in rectal cancer treatment was evaluated. METHODS: Population-based data of the Dutch Surgical Colorectal Audit, including 3,104 patients undergoing rectal cancer resection between January 2009 and July 2012 in 92 hospitals, were used. Hospital variation in (case-mix-adjusted) defunctioning stoma rates was calculated. Anastomotic leakage and 30-day mortality rates were compared in hospitals with a high and low tendency towards stoma construction. RESULTS: Of all patients, 76 % received a defunctioning stoma; 9.6 % of all patients developed anastomotic leakage. Overall postoperative mortality rate was 1.8 %. The hospitals' adjusted proportion of defunctioning stomas varied from 0 to 100 %, and there was no significant correlation between the hospitals' adjusted stoma and anastomotic leakage rate. Severe anastomotic leakage was similar (7.0 vs. 7.1 %; p = 0.95) in hospitals with the lowest and highest stoma rates. Mild leakage and postoperative mortality rates were higher in hospitals with high stoma rates. CONCLUSIONS: A high tendency towards stoma construction in rectal cancer surgery did not result in lower overall anastomotic leakage or mortality rates. It seems that the ability to select patients for stoma construction is the key towards preferable outcomes, not a risk adverse strategy.


Assuntos
Fístula Anastomótica/epidemiologia , Hospitais/estatística & dados numéricos , Estomia/estatística & dados numéricos , Qualidade da Assistência à Saúde , Neoplasias Retais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/mortalidade , Feminino , Administração Hospitalar , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Política Organizacional , Adulto Jovem
4.
Dis Colon Rectum ; 57(4): 460-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24608302

RESUMO

BACKGROUND: Synchronous colorectal carcinoma occurs in 1% to 8% of cases. There are little data on the impact of synchronous colorectal cancer on surgical treatment and short-term postoperative outcomes. OBJECTIVE: The purpose of this work was to evaluate clinical characteristics and treatment patterns of synchronous colorectal carcinoma and their influence on short-term postoperative outcomes in comparison with solitary colorectal carcinoma. DESIGN: This was a population-based observational study. Patient and tumor characteristics, treatment patterns, and postoperative outcomes are described for patients with a solitary and synchronous colorectal carcinoma separately. Multivariable logistic regression analysis was used to analyze the association between synchronous colorectal carcinoma and postoperative complications in comparison with a solitary colorectal carcinoma. SETTINGS: The study included in-hospital registration for the Dutch Surgical Colorectal Audit. PATIENTS: Patients were those with primary colorectal carcinoma from 2009 to 2011. MAIN OUTCOME MEASURES: Severe postoperative complications, reinterventions, and 30-day mortality were measured. RESULTS: Of 25,413 patients with colorectal cancer, 884 (3.5%) had synchronous colorectal tumors. Patients with synchronous colorectal carcinoma were older and more often of male sex compared with patients with solitary colorectal carcinoma. In ≥ 35% of cases, an extended surgical procedure was conducted (n = 310). In multivariable logistic regression analysis, synchronous colorectal carcinoma was associated with a higher risk of severe postoperative complications (OR, 1.40; 95% CI, 1.20-1.63) and reinterventions (OR, 1.37; 95% CI, 1.14-1.65) compared with solitary colorectal carcinoma but not with higher 30-day mortality (OR, 1.34; 95% CI, 0.96-1.88). LIMITATIONS: This study was limited by the data being self-reported. Case-mix adjustment was limited to information available in the data set, and no long-term outcome data were available. CONCLUSIONS: Synchronous colorectal carcinomas are prevalent in 3.5% of patients and require a different treatment strategy in comparison with solitary colorectal carcinoma. Postoperative outcomes are unfavorable, most likely because of extensive surgery.


Assuntos
Colectomia , Neoplasias Colorretais/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Complicações Pós-Operatórias/etiologia , Reto/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Primárias Múltiplas/mortalidade , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Reoperação , Fatores de Risco , Autorrelato , Resultado do Tratamento
5.
J Surg Oncol ; 109(6): 567-73, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24338627

RESUMO

BACKGROUND: Mortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections. METHODS: Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011-2012. Severe complication- and FTR rates were compared between the groups in univariate and multivariate analysis. RESULTS: Colon cancer (CC) patients (n = 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n = 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06-3.37). CONCLUSIONS: Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non-)surgical complications, especially in colon cancer surgery.


Assuntos
Colectomia/estatística & dados numéricos , Neoplasias do Colo/cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Distribuição por Idade , Idoso , Auditoria Clínica , Colectomia/métodos , Comorbidade , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Unidades de Terapia Intensiva , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Análise Multivariada , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Estomas Cirúrgicos/estatística & dados numéricos
6.
Ann Surg ; 257(5): 916-21, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22735713

RESUMO

OBJECTIVE: To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study. BACKGROUND: Although laparoscopic techniques are increasingly used in colorectal cancer surgery, little is known on results outside trials. With the fast introduction of laparoscopic resection (LR), questions were raised about safety. METHODS: Of all patients who underwent an elective colorectal cancer resection in 2010 in the Netherlands, 93% were included in the Dutch Surgical Colorectal Audit. Short-term outcome after LR, open resection (OR), and converted LR were compared in a generalized linear mixed model. We further explored hospital differences in LR and conversion rates. RESULTS: A total of 7350 patients, treated in 90 hospitals, were included. LR rate was 41% with a conversion rate of 15%. After adjustment for differences in case-mix, LR was associated with a lower risk of mortality (odds ratio 0.63, P < 0.01), major morbidity (odds ratio 0.72, P < 0.01), any complications (odds ratio 0.74, P < 0.01), hospital stay more than 14 days (odds ratio 0.71, P < 0.01), and irradical resections (odds ratio 0.68, P < 0.01), compared to OR. Outcome after conversion was similar to OR (P > 0.05). A large variation in LR and conversion rates among hospitals was found; however, the difference in outcome associated with operative techniques was not influenced by hospital of treatment. CONCLUSIONS: Use of laparoscopic techniques in colorectal cancer surgery in the Netherlands is safe and results are better in short-term outcome than open surgery, irrespective of the hospital of treatment. Outcome after conversion was similar to OR.


Assuntos
Colectomia/métodos , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Laparoscopia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/mortalidade , Colectomia/estatística & dados numéricos , Neoplasias Colorretais/mortalidade , Conversão para Cirurgia Aberta/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/mortalidade , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Laparoscopia/mortalidade , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Modelos Lineares , Modelos Logísticos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Resultado do Tratamento
7.
Ned Tijdschr Geneeskd ; 156(22): A4794, 2012.
Artigo em Holandês | MEDLINE | ID: mdl-22647229

RESUMO

Postoperative ileus is a commonly occurring complication after abdominal surgery. Reduced well-being and ileus related complications lead to extension of hospital stay. An early commencement of postoperative feeding to stimulate the digestive system is not always achievable in practice. Recent studies suggest that use of chewing gum can be effective in preventing postoperative ileus by a similar mechanism of action to early postoperative feeding. However, these studies were small in size and of varying quality. Recently the "Chewing gum study" ("Kauwgomstudie") to investigate the effect of general use of chewing gum after abdominal surgery has been started in the Netherlands.


Assuntos
Goma de Mascar , Íleus/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Defecação , Digestão/fisiologia , Procedimentos Cirúrgicos Eletivos , Flatulência , Humanos , Laparotomia/efeitos adversos , Tempo de Internação , Países Baixos
8.
Ned Tijdschr Geneeskd ; 155(45): A4136, 2011.
Artigo em Holandês | MEDLINE | ID: mdl-22085580

RESUMO

OBJECTIVE: To determine whether systematic audit and feedback of information about the process and outcomes improve the quality of surgical care. DESIGN: Systematic literature review. METHOD: Embase, PubMed, and Web of Science databases were searched for publications on 'quality assessment' and 'surgery'. The references of the publications found were examined as well. Publications were included in the review if the effect of auditing on the quality of surgical care had been investigated. RESULTS: In the databases 2415 publications were found. After selection, 28 publications describing the effect of auditing, whether or not combined with a quality improvement project, on guideline adherence or indications of outcomes of care were included. In 21 studies, a statistically significant positive effect of auditing was reported. In 5 studies a positive effect was found, but this was either not significant or statistical significance was not determined. In 2 studies no effect was observed. 5 studies compared the combination of auditing with a quality improvement project with auditing alone; 4 of these reported an additional effect of the quality improvement project. CONCLUSION: Audit and feedback of quality information seem to have a positive effect on the quality of surgical care. The use of quality information from audits for the purpose of a quality improvement project can enhance the positive effect of the audit.


Assuntos
Auditoria Médica/normas , Neoplasias/cirurgia , Serviço Hospitalar de Oncologia/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Procedimentos Cirúrgicos Operatórios/normas , Humanos
9.
Pain Med ; 11(11): 1628-34, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21044253

RESUMO

OBJECTIVE: Despite the technical developments in surgical procedures, chronic poststernotomy pain (CPSP) is still very common. Many theories for its cause have been proposed in the literature, but the etiology is still not clear. Pain along the sternal scar and in the upper extremities (sometimes accompanied with paresthesia) persists in about 30% of cases. These symptoms have been regarded as two separate complications. This study investigated all pain symptoms in patients following sternotomy. DESIGN: Retrospective pilot study. SETTING: Outpatient clinic at the Leiden University Medical Center. PATIENTS: A cohort of patients who underwent open heart surgery by median sternotomy between January 1, 2004 and January 1, 2006. INTERVENTIONS: A questionnaire was completed by 631 patients, and a selected sample of 277 patients was examined for pain of the head, neck, back, and chest and upper extremities. OUTCOME MEASURES: All pain locations were compared in two groups: 189 patients with sternal pain and 88 patients without sternal pain. RESULTS: We found that pain and muscular tenderness in the investigated areas unrelated to the chest wall incision were significantly more common in patients with sternal pain compared to the nonsternal pain group. No surgical or demographic factors with the exception of female gender were consistent predictors of sternal pain. CONCLUSION: CPSP is an extensive pain syndrome. Sternal pain is frequently accompanied by pain of the head, neck, back, and upper extremities. Further research on the possible etiology is warranted.


Assuntos
Dor/etiologia , Complicações Pós-Operatórias/etiologia , Esternotomia/efeitos adversos , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
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